Healthcare Provider Details

I. General information

NPI: 1871028290
Provider Name (Legal Business Name): KATHRYN STIGLIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 S MARYLAND AVE
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

5741 S MARYLAND AVE
CHICAGO IL
60637-1425
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6169
  • Fax:
Mailing address:
  • Phone: 773-702-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.164109
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: